Methadone treatment for opioid dependency in Australia dates back to 1969, when a medical practitioner in New South Wales first began prescribing it. The apparent rise in illnesses, crime and death associated with opioids during the 1980's led to methadone maintenance being endorsed as an effective method of treatment in 1985.
Methadone maintenance treatment is now available in every Australian State and Territory with the exception of the Northern Territory. The growth in the number of clients since its inception has been accompanied by a diversity in treatment settings, and an increasing role for the private sector in the provision of services. In 1993, a National Methadone Policy was adopted, based on National Methadone Guidelines which had been operational since 1987. The policy reflects a national position on the role of methadone, and provides core operational procedures to guide the provision of services. The policy was endorsed by the Ministerial Council on Drug Strategy in 1993, and is distributed widely throughout Australia.
The goals for methadone treatment as identified in the policy are:
"to reduce the health, social and economic harms to individuals and the community associated with illegal opioid use."
The key objectives to achieve these goals are:
- "to reduce unsanctioned opioid use;
- to reduce other unsanctioned drug use;
- to improve the health of clients;
- to help reduce the spread of infectious diseases associated with illegal opioid use, especially HIV/AIDS and Hepatitis B and C;
- to reduce deaths associated with illegal opioid use;
- to reduce crime associated with illegal opioid use; and
- to facilitate an improvement in social functioning."
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Accompanying these changes has been an increasing role for the private sector in the provision of services which has been funded through Medicare. This led to concern in the Commonwealth Department of Human Services and Health about the increasing costs this incurs to the Commonwealth, and a perceived imbalance in the agreed cost-sharing arrangements with the States. In 1989, an inquiry into funding arrangements for methadone maintenance treatment recommended a new funding formula for public and private services, but failed to gain national agreement.
The private sector is now seen by some as providing the major means of expanding methadone maintenance treatment in most jurisdictions. This has resulted from increased client demand, and the limited capacity of the public sector to respond to this demand. However, the diversity of settings and service providers participating in methadone maintenance, including private general practitioners and psychiatrists, purpose built clinics catering for large numbers of clients, and community pharmacies has led to a complex service environment. This is made even more complex by the interaction between the public and private sectors, resulting in sharing of clinical responsibilities and costs.
The increasing role of the private sector offers many advantages, particularly in regard to improved client access to services and equity. At the same time, there is a need to ensure that services are provided in a cost-effective manner, and at a standard which is commensurate with client safety and care needs. This review has been undertaken to address the service delivery infrastructure and funding mechanisms, and to make recommendations on how these aspects of service delivery and management may be improved. The Terms of Reference for the review are provided in the following section.
An important part of the review has been the examination of the comparative effectiveness of alternative service delivery models in the public and private sectors and their associated costs. This required the collection of data relating to both the clinical outcomes of treatment, and the costs associated with the achievement of those outcomes. Both these dimensions are addressed in the report. However, reliable data on the costs of methadone treatment services provided in both the public and private sectors in most jurisdictions in Australia are difficult to obtain. In the public sector, this is due primarily to the fact that the costs of methadone services are often included with those of other drug and alcohol services, and are not separately identified. In the private sector, the fact that methadone services are not separately identified in the Commonwealth Medicare Benefits Schedule (CMBS) makes it difficult to identify their costs. For these reasons, estimates of costs have been made based on information provided by State and Territory health authorities, together with data from the Health Insurance Commission and private practitioners on treatment profiles and their associated costs in the private sector.
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